Sight problems in older people

This is a clouding of the lens of the eye. The commonest type is due to increasing age and up to half of people over age 60 are affected to some degree. Symptoms may include less clear vision, dimming of colours and being dazzled by headlights. New glasses may help to start with but once symptoms are interfering with daily activities, surgery to replace the lens is usually recommended. This is a straightforward procedure and often done under local anaesthetic.

You might find this information from Moorfields NHS eye hospital useful.

Glaucoma refers to a group of conditions where the optic nerve at the back of the eye is damaged, usually by raised pressure inside the eyeball. It affects almost 10% of people over age 75. Glaucoma can lead to loss of peripheral vision (“tunnel vision”) and even to central vision loss if not detected and treated.

There are different causes but the type which is commonest in later life (“open-angle glaucoma”) develops gradually and there may be no symptoms in the early stages, meaning it is often picked up on a routine eye test. You are more at risk if you have a first-degree relative (parent/ sibling/child) with glaucoma, are of Afro-Caribbean ethnicity, are short-sighted, a diabetic or have taken steroids for a long period. Treatment will stop your vision from getting any worse and usually starts with daily eye drops to reduce the pressure. For most people, this is sufficient, but the drops have to be continued for life. Laser treatment or surgery is necessary in some cases.

In rare cases, there is a rapid-onset or acute form of glaucoma (“angle-closure glaucoma”) which is a medical emergency.

Acute glaucoma is a sudden rise in pressure in the eye when the drainage channels in the eye become blocked. Symptoms may include a red and intensely painful eye with blurred vision, a headache, nausea and vomiting. You may see rainbow-coloured rings around bright white lights. Some people feel generally unwell, have a hard, tender eyeball and the cornea may look hazy. Risk factors include smaller eyes, being long-sighted, female sex, Asian and Indian ethnicity and a family history of acute glaucoma.

Glaucoma UK has helpful information.

Flashes of light at the edge of your vision occur when the jelly or “vitreous humour” inside your eye shrinks and tugs on the light-sensitive retina at the back of your eye. An occasional flash may be harmless but new or increasing symptoms may be a warning sign that the retina is tearing and detaching from the back of the eye. This is called a “retinal detachment” and is a medical emergency which needs urgent medical attention.

Floaters appear as spots, threads or cobweb effects when you look at a plain surface or a bright sky and are caused by clumping together of fibres in the clear vitreous humour as it shrinks. Mild floaters, particularly if you have had them for a long time, they have been assessed by your optometrist and they are not changing, are usually harmless and don’t need any treatment. They may persist over time or gradually become less noticeable.

If you notice a sudden shower of new floaters, if floaters and flashes are getting worse or occurring together, if you see a black shadow or curtain effect moving across your vision or experience any sudden change in your vision or loss of vision, seek urgent advice. These can be signs of retinal detachment which can result in permanent sight loss. Urgent treatment to stick the retina back down gives you a better chance of a full recovery. There are several techniques used including laser or freezing (cryotherapy) treatment.

The Association of Optometrists has some helpful advice here.

This is the biggest cause of sight loss in the UK.

The macula is a special area of the central retina which allows you to see fine details clearly. AMD causes gradual loss of central vision (eg the ability to recognise faces and to read) but not blindness, as peripheral vision is preserved. Other symptoms include a distorted or blurred area of vision, less vivid colours or straight lines looking crooked or wavy. Sometimes there are no symptoms and it is picked up on a routine eye test.

About 75% of people have the milder form or “dry AMD”, often with near-normal vision. Less common is “wet AMD”, characterized by abnormal blood vessel formation around the macula which can lead to severe and permanent loss of central vision.
The cause is unknown but it has been linked to factors such as smoking, high blood pressure and having a family history of AMD.

Treatment is only needed for Wet AMD. You can find out more at The Macular Society website.

This is a complication of diabetes which can cause sight loss if left untreated. Please see our information about diabetes.

This is common over age 50. It is usually due to an inefficient lubricating tear film which evaporates too quickly, doesn’t coat the eye well and leaves the surface of the eye dry and irritated. The eye may have a gritty or burning sensation, you might have brief blurring of vision or mild increased sensitivity to light, and sometimes even leads to a watery eye, despite the eye itself being dry. Although uncomfortable, it doesn’t normally cause pain or poor vision. Many factors can make it worse such as central heating/air conditioning, staring at a computer screen, wearing contact lenses, smoking, drinking alcohol and some medications and underlying health conditions. If the eyelids become sore and red, this is called blepharitis.
There are lots of different artificial tear drops and gels which can be used, sometimes with a longer-lasting ointment for use at night. Some people can become sensitive to the preservatives in eye drops and may need a preservative-free preparation. This is advised if drops need to be used more than 4-6 times per day. Ask your optometrist or pharmacist for advice.

Guys and St Thomas hospital has this useful information leaflet.